Stomach cancer remains one of the deadliest forms of cancer worldwide because it often goes undetected until reaching advanced stages. Similar to colorectal cancer, stomach cancer frequently progresses silently without obvious early symptoms. The low survival rate associated with stomach cancer stems primarily from late-stage diagnosis rather than the disease being inherently untreatable. When detected early, stomach cancer is often curable, and screening can identify precancerous changes before cancer ever develops, making awareness critical for those at elevated risk. Recognizing this gap, the American Gastroenterological Association recently released updated 2025 guidelines focused on identifying and screening high-risk individuals before cancer develops.1

Overview of Stomach Cancer

Stomach cancer, also called gastric cancer, develops when cells in the stomach lining begin growing abnormally and form malignant tumors. Most stomach cancers begin in the mucus-producing cells that line the inner surface of the stomach, though cancer can technically develop in any part of this organ. The stomach’s lining consists of multiple layers of tissue, and cancer typically starts in the innermost layer before potentially spreading deeper into the stomach wall or beyond to nearby organs and lymph nodes.

The disease tends to progress slowly over many years, often moving through several precancerous stages before becoming invasive cancer. This gradual development usually involves changes in the stomach lining cells, where normal tissue can transform into abnormal patterns like intestinal metaplasia. These abnormal areas may progress further to dysplasia, where cells show increasingly disordered growth patterns that can eventually become cancerous. The most common factor associated with this progression is long-term infection with Helicobacter pylori bacteria, which causes persistent inflammation in the stomach lining. Other factors including smoking, diet high in salt and preserved foods, and genetic predisposition also play roles in stomach cancer development.

The gradual nature of stomach cancer development creates both a challenge and an opportunity. The challenge lies in the disease’s subtle early symptoms; many people experience no noticeable problems during precancerous stages, or they dismiss mild discomfort as ordinary indigestion. By the time symptoms become severe enough to prompt medical evaluation, cancer may have already spread beyond the stomach lining. The opportunity comes from this same slow progression: early changes in the stomach lining can be detected and treated long before they transform into cancer, making stomach cancer largely preventable when caught at the right time.

Who Is at Risk for Developing Stomach Cancer?

Certain groups face significantly higher stomach cancer risk than the general population, making them good candidates for proactive screening. For instance, having a parent, sibling, or child diagnosed with stomach cancer can increase risk by two to ten times compared to someone with no family history. Also, though the reasons are not well understood, people of East Asian, Hispanic, Black, or Native American ancestry develop stomach cancer at notably higher rates. First-generation immigrants from regions where stomach cancer is common, such as East Asia, Eastern Europe, and parts of Central or South America, carry elevated risk that likely relates to environmental exposures and dietary patterns from their countries of origin.

Beyond background and heritage, specific medical conditions increase stomach cancer risk substantially. Chronic infection with H. pylori bacteria remains the most significant modifiable risk factor for stomach cancer. Autoimmune gastritis, often associated with pernicious anemia and vitamin B12 deficiency, causes chronic inflammation and thinning of the stomach lining that raises cancer risk over time. Additionally, people with certain hereditary cancer syndromes like hereditary diffuse gastric cancer, Lynch syndrome, or familial adenomatous polyposis face elevated risk and typically require specialized screening protocols developed in consultation with genetic counselors.

Screening for Stomach Cancer

The tendency for stomach cancer to develop quietly without obvious symptoms makes waiting for warning signs a risky approach. By the time persistent pain, unexplained weight loss, or other clear symptoms appear, cancer has often progressed beyond the early stages where treatment is most effective. Regular screening allows doctors to identify precancerous changes or very early cancers long before symptoms would ever develop. Recognizing this critical window for intervention, the American Gastroenterological Association's 2025 guidelines recommend proactive screening for people in high-risk categories, including those with family history, certain ethnic backgrounds, H. pylori infection, autoimmune gastritis, or hereditary cancer syndromes.

The go-to screening procedure for stomach cancer is an upper endoscopy, which involves a thin, flexible camera being passed down the esophagus and directly into the stomach. In addition to direct visualization of the stomach lining, an endoscopy allows the gastroenterologist to obtain tissue samples or even remove irregularities like polyps. The procedure is typically performed with the patient under light sedation and takes 10-15 minutes. Biopsies taken during an endoscopy can then be tested in a lab for H. pylori infections or evidence of metaplasia or dysplasia.

Treatment Options Based on Screening Results

The treatment approach for stomach cancer depends heavily on when the disease is detected and how far it has progressed. When screening identifies precancerous changes like intestinal metaplasia or early-stage dysplasia, the primary focus shifts to eliminating H. pylori infection if present and establishing a surveillance schedule to monitor for progression. For more advanced findings, treatment options range from minimally invasive endoscopic procedures to surgical intervention:

  • H. pylori eradication: When an H. pylori infection is detected, doctors prescribe combination antibiotic therapy to eliminate the bacteria. Clearing this infection can prevent precancerous changes from progressing and may even allow some early abnormalities to reverse. Follow-up testing confirms the infection has been successfully eradicated.
  • Endoscopic resection: For high-grade dysplasia or very early-stage cancer confined to the stomach’s inner lining, endoscopic submucosal dissection allows doctors to remove abnormal tissue during an endoscopy procedure. This minimally invasive approach can be curative when cancer is caught early and avoids the need for major surgery.
  • Surgical removal: When cancer has grown deeper into the stomach wall or spread to nearby lymph nodes, partial or total gastrectomy may be necessary. The extent of surgery depends on the tumor’s size, location, and stage of development.
  • Ongoing surveillance: After treatment of precancerous conditions or early cancer, regular follow-up endoscopies monitor for recurrence or new abnormal areas. Surveillance intervals typically range from one to three years depending on initial findings and risk factors.

Schedule a Stomach Cancer Screening

If you fall into any of the high-risk categories for stomach cancer or have concerns about your family history, getting screened sooner rather than later can make a critical difference in your health outcomes. Stomach cancer can often be prevented through early detection of precancerous changes, and is highly treatable when caught in its earliest stages. The experienced gastroenterologists at Cary Gastro follow the latest AGA guidelines to provide comprehensive screening and personalized care for patients at elevated risk. Don’t wait for symptoms to develop. Contact us today to request an appointment and take a proactive approach to protecting your digestive health.


1https://www.gastrojournal.org/article/S0016-5085(24)05663-4/fulltext